The AMA call was a tough one for a variety of
reasons not least of which is that there is no general agreement in the
scientific community on the definition of disease. The Times piece explains, “Those arguing against it [the
designation of obesity as a disease] say that there are no specific symptoms
associated with it and that it is more of a risk factor for other conditions
than a disease in its own right.” In fact, in making the designation, the AMA
delegates at their annual convention overrode a recommendation against
doing so by a committee that had studied the matter for a year.

The committee said that “obesity should not be
considered a disease mainly because the measure usually used to define obesity,
the body mass index, is simplistic and flawed,” according to The Times. The committee argued that
“some people with a B.M.I. above the level that usually defines obesity are
perfectly healthy while others below it can have dangerous levels of body fat
and metabolic problems associated with obesity.” The committee wrote, “Given
the existing limitations on B.M.I. to diagnose obesity in clinical practice, it
is unclear that recognizing obesity as a disease, as opposed to a ‘condition’
or ‘disorder,’ will result in improved health outcomes.”

The AMA finessed the B.M.I business by “simply
defining obesity as an excess of body fat sufficiently large to cause reduced
health and longevity,” according to a long
piece
in Forbes by Chris Conover. According
to Conover, “they answered the question of ‘should we consider obesity a
disease’ largely on utilitarian grounds that the social benefits of doing so
will outweigh the costs.” Conover then goes on to totally and brilliantly
demolish that argument.

Besides, Conover says, “the AMA is (late) to the
party.” He notes that the National Institutes of Health declared in 1985 that
“obesity is a serious health condition that leads to increased morbidity and
mortality.” And The National Heart, Lung and Blood Institute commented in 1995
that “obesity is a multifactorial chronic disease developing from multiple
interactive influences of numerous factors.” He cites the Surgeon General’s
2001 Call to Action to Prevent and Decrease Overweight and Obesity, and
Michelle Obama’s 2009 Taskforce on Childhood Obesity. Even the IRS more than a
decade ago considered obesity to be a disease, and Medicaid jumped on the
bandwagon in 2010. Medicare has too for counseling and surgery, but not for reimbursement for weight
loss drugs.What then could the
AMA’s motive be in defining obesity as a disease now?

The Times gives us a clue (if we
needed one) to a pecuniary motive for the AMA action. One advocate commented,
“I think you will probably see from this physicians taking obesity more
seriously, counseling their patients about it.” And, The Times noted, “…it could help improve reimbursement for obesity
drugs, surgery and counseling.” They note, “Two new obesity drugs – Qsymia…and
Belviq…have entered the market in the last year,” and “Qsymia has not sold well
for a variety of reasons, including poor reimbursement…” At the Huffington Post, self-described policy
wonk and blogger Larry Cohen enthusiastically huffed, “After the AMA
announcement, some members of Congress introduced a bill to expand Medicare
reimbursements for weight-loss drugs and weight-reduction treatment.” The
Washington lobbyists jumped in exaltation.

Another view is that designating obesity as a
disease, like alcoholism or other addictions, “would reduce the stigma of
obesity that stems from the widespread perception that it is simply the result
of eating too much or exercising too little.” And then The Times piece cracks the door open just a bit with, “Some doctors
say that people do not have full control over their weight.” Are they hinting
that obesity may be a condition of genetic susceptibility? (Again, see my next
column, #148, next Wednesday.) Another naysayer would remark “that ‘medicalizing’ obesity by declaring
it a disease would define one-third of American as being ill and could lead to
more reliance on costly drugs and surgery rather than lifestyle changes. Some
people might be overtreated because their B.M.I. was above a line designating
them as having a disease, even though they were healthy.” I agree. Besides, if the treatment is merely treating a symptom (obesity), rather than
the underlying disease, doesn’t that solidify in the medical protocols a
wrong treatment modality for a non-existent disease? The AMA finessed that too
in their final resolution by saying that obesity was a “multimetabolic and
hormonal disease state” (thus avoiding using “disease” as a noun) that leads to
unfavorable outcomes like type 2 diabetes and cardiovascular disease.”

What might the underlying disease be? Obviously, neither The Times nor the AMA subscribes to Gary
Taubes’s Alternative Hypothesis that insulin
resistance, the metabolic disregulation that characterizes type 2
diabetes, is what leads to fat
accumulation (obesity). The Times later posted that the article now
“correctly noted” (NOT) that “obesity
can lead to type 2 diabetes.” As Taubes (and others) have pointed out, The Times together with most of the “old
school” medical establishment has got the “cause and effect” of obesity exactly
backwards. Oh well, it’s still a long road back to sanity.

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.